Just look at the list of who the lowest-paid people are. Pediatricians are at the bottom. You would also look at internists. You would look at psychiatrists. You would look at family physicians, HIV specialists. People who take care of chronic illnesses by seeing people carefully over time, those are the people who get the least money. The people who have the most are people like orthopedic surgeons, interventional cardiologists. And my point isn't that there is something wrong with heroism.

After readinf some essay on the nature of human fallibility, I was very aware that we are the recipients of a huge amount of discovery over the last century. Medicine exemplifies this. And that has transitioned us from a world in which people's lives were mostly governed by ignorance to one that's constrained by ineptitude. A century ago, we didn't know, for instance, what diseases afflicted us, what their nature really was, or what to do about them. And that has changed.

In one study, old people assigned to a geriatrics team stayed independent for far longer, and were admitted to the hospital less.

I think the extreme complexity of medicine has become more than an individual clinician can handle. But not more than teams of clinicians can handle.

Culture matters. Of course, if physicians are rewarded or penalized for their service and results, the culture will change. But the key values we doctors are being pressed to embrace are humility, teamwork, and discipline.

What is needed, however, isn't just that people working together be nice to each other. It is discipline. Discipline is hard--harder than trustworthiness and skill and perhaps even than selflessness. We are by nature flawed and inconstant creatures. We can't even keep from snacking between meals. We are not built for discipline. We are built for novelty and excitement, not for careful attention to detail. Discipline is something we have to work at.

When we lived in a society where we had large families that lived together, especially in agricultural societies like my grandfather and father grew up in, the result is you always had family around to take care of you.